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7361 Hem/Onc Block 3 > Solid Organ Transplant > Flashcards

Solid Organ Transplant Flashcards

1
Q

Which organ has lowest risk of rejection?

a. heart
b. kidney
c. lung
d. liver

A

d. liver

lung > kidney > heart > liver

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2
Q

Recipient APCs present piece of donor to T cells which activates B cell, NK cells, etc

a. direct recognition
b. indirect recognition

A

b. indirect recognition

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3
Q

What is the primary polyclonal antibody induction Tx?

A

rabbit anti-thymocyte globulin

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4
Q

What is the primary monoclonal antibody induction Tx?

A

basiliximab (Simulect)

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5
Q

What glucocorticoid is used for induction?

A

methylprednisolone

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6
Q

T cell depletion is usually observed within a day from initiating thyroglobulin therapy

a. true
b. false

A

a. true

extremely potent T cell depletion

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7
Q

Manufacture of ATG:

rabbits are immunized with human ___

A

thymocytes

serum harvested from rabbits, immunoglobulins against human thymocytes isolated/purified

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8
Q

rATG is infused over ___ hours initially

A

6

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9
Q

Peripheral rATG infusion requires addition of __ and __ to the bag

A

heparin, hydrocortisone

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10
Q

rATG ADRs:

Post transplant lymphoproliferative disorder (PTLD) is associated with what virus?

A

Epstein Barr

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11
Q

rATG ADRs:

Infection is associated with profound lymphopenia for >= __ to __ months

A

3, 6

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12
Q

If platelets are < ___ hold rATG administration

A

50

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13
Q

If WBCs are < ___ hold rATG administration

A

2

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14
Q

4 ADRs of rATG?

A

cytokine-release syndrome
cytopenias
infection
post-transplant lymphoproliferative disorder (PTLD)

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15
Q

Monoclonal induction:

Basiliximab is a chimeric monoclonal antibody against ___ antigen/IL2 receptor

A

CD25

CD25 is on activated T cells;
basiliximab inhibits T-cell proliferation through inhibition of IL2 signaling

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16
Q

Basiliximab does not deplete T cells but makes them inactive for __ to __ weeks

A

4, 6

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17
Q

Basiliximab is T-cell depleting

a. true
b. false

A

b. false

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18
Q

___ is used for induction and rejection

a. rATG
b. basiliximab

A

a. rATG

basiliximab only for induction

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19
Q

No pre-medicaiton is required for induction with basiliximab

a. true
b. false

A

a. true

virtually no ADRs

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20
Q

Glucocorticoids display anti inflammatory and immunosuppressive activity by blocking __ expression

A

cytokine

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21
Q

Glucocorticoids are used for ___

a. induction
b. maintenance
c. cellular rejection

select al that apply

A

a-c

maintenance dose Is 5mg

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22
Q

PRA > __ % needs potent induction

A

20

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23
Q

___ prevents long term allograft rejection

a. induction
b. maintenance

A

b. maintenance

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24
Q

4 classes of maintenance immunosuppressants?

A
  • calcineurin inhibitors
  • anti-proliferatives
  • corticosteroids
  • costimulation inhibitors
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25
Signal one is ___ a. TCR b. costimulation molecules c. binding of IL2 to CD25 receptor
TCR
26
Signal two is __ a. TCR b. costimulation molecules c. binding of IL2 to CD25 receptor
b. costimulation molecules
27
Signal 3 is ___ a. TCR b. costimulation molecules c. binding of IL2 to CD25 receptor
c. binding of IL2 to CD25 receptor
28
Maintenance: Which calcineurin inhibitor has erratic absorption/poor bioavailability and requires bile salts?
cyclosporine non-modified
29
Cyclosporine modified is interchangeable with or bioequivalent o cyclosporin non-modified a. true b. false
b. false NOT interchangeable
30
Calcineurin inhibitors prevent dephosphorylation of ___
NFAT NFAT cannot enter the nucleus to activate T lymphocytes
31
Calcineurin inhibitors block which signal? a. 1 b. 2 c. 3
a. 1 TCR results in inhibition of IL2 mediated T lymphocyte activation
32
Which correlates better with clinical outcomes of calcineurin inibitrors? a. Co (12 hr trough) b. C2 (2 hr peak)
b. C2 (2hr peak Co doesn't correlate clearly with aUC but is easiest to obtain, so most frequently used
33
What HEENT AE does cyclosporine cause?
gingival hyperplasia
34
What CV AEs does cyclosporine cause?
HTN | hyperlipidemia
35
Which is more nephrotoxic cyclosporine or tacrolimus?
a. cyclosporine
36
Cyclosporine causes hirsutism a. true b. false
a. true
37
Tacrolimus binds to ___
FKBP12 NFAT cannot enter nucleus to activate IL2 gene transcription
38
___ is more effective at preventing rejection a. tacrolimus b. cyclosporine
a. tacrolimus
39
Reduce oral tacrolimus dose by ___ % for sublingual dose
50
40
Administer only __ % of tacrolimus PO dose if giving it IV continuous infusion
25
41
Which causes more tremor? a. tacrolimus b. cyclosporine
a. tacrolimus
42
Which causes more diabetes and alopecia? a. tacrolimus b. cyclosporine
a. tacrolimus
43
Azathioprine is what drug class?
antimetabolite
44
Azathioprine is a prodrug and is converted to ___
6-MP purine analog blocks de novo synthesis of purines
45
Azathioprine blocks which signal? a. 1 b. 2 c. 3
c. 3 inhibits proliferation of rapidly dividing cells including T and B lymphocytes
46
Azathioprine is primarily ___ eliminated
renally
47
Azathioprine is 100% bioavailable a. true b. false
a. true
48
TDM is required for calcineurin inhibitors a. true b. false
a. true
49
TDM is not typically performed for azathioprine a. true b. false
a. true
50
What is main AE of azathioprine?
hepatotoxicity
51
Monitor renal function with azathioprine a. true b. false
a. true
52
DDIs: Azathioprine and allopurinol should not be administer concomitantly a. true b. falsel
a. true
53
antimetabolites: maintenance mycophenolate mofetil and mycophenolate sodium are converted to ___
mycophenolic acid (MPA) exhibitors key enzyme for purine biosynthesis
54
Mycophenolate blocks which signal? a. 1 b. 2 c. 3
c. 3 blocks signal necessary for proliferation of T and B lymphocytes
55
When converting MMF to MPS, 250mg MMF = ___ mg MPS
180
56
1000mg MMF = __ mg MPS
720
57
TDM is typically performed with mycophenolate a. true b. false
b. false
58
Consider dose reduction or d/c of antiproliferative in the setting of ongoing ___
infection
59
PPIs do not impact ___ absorption a. MMF b. MPA c. MPS
c. MPS
60
___ pH is necessary for MMF solubility a. acidic b. alkaline
a. acidic
61
Sirolimus MOA?
prevents G1 to s phase of cell cycle blocks signal 3, IL2 mediated T lymphocyte proliferation
62
TDM is required with mTORs a. true b. false
a. true sirolimus, tacrolimus
63
Goal level for sirolimus?
5-10ng/mL Co (24hr trough) correlates to AUC and clinical outcomes
64
Which maintenance Tx can cause hypertriglyceridemia, thrombosis, proteinuria, and delayed wound healing?
sirolimus
65
Which maintenance treatment has a BBW for liver and lung transplant?
sirolimus
66
Avoid sirolimus within how long of liver transplant?
one month avoid within 3 months of lung transplant
67
Which mTOR has better bioavailability? a. sirolimus b. everolimus
b. everolimus 30% vs 15%
68
Check everolimus level every __ hours
12 sirolimus = 24hrs
69
Everolimus has same side effects as sirolimus, but is better tolerated a. true b. false
a. true
70
Is TDM performed with prednisone?
no
71
belatacept drug class?
co-stimulation inhibitor binds to APC (CD80/86) and blocks co stimulation signal blocking signal 2 prevents T-lymphocyte activation and can cause anergy and apoptosis
72
Is TDM performed for the costimulation inhibitor belatacept?
no DDI are minimal
73
Belatacept exposure is not impacted by renal or hepatic function a. true b. false
a. true linear kinetics
74
3 main side effects of the costimulation inhibitor belatacept?
infusion reactions malignancy diarrhea post transplant lymphoproliferative disorder more frequent in eBV seronegative (IgG -) pts
75
Acute cellular rejection is mediated by what?
T-lymphocytes
76
mild to moderate cellular rejection receives what Tx?
methylprednisolone | augmentation
77
moderate to severe cellular rejection receives what Tx?
methylprednisolone augmentation T-lymphocyte depleting agent
78
Antibody mediated rejection is mediated by what?
donor specific antibodies DSAs secreted by mature B lymphocytes (plasma cells)

7361 Hem/Onc Block 3 (9 decks)

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